Post on 17-Jul-2020
transcript
9th of June 2020
Dra. Nerea García BenzaquénHead of the Neglected and Emerging Unit
VISAVET-UCMngarciab@visavet.ucm.es
HIV +§ Discomfort§ Diarrhea§ Jaundice§ Vomiting§ Fever§ liver enzyme alteration
HEPATITIS SEROLOGY: HEPATITIS A, B, C, E (ELISA)
HEPATITIS E VIRUS IN SERUM (PCR)
October 2015. Hospital Reina Sofía Córdoba.
HEV PCR
FAMILY MEMBERS
EPIDEMIOLOGY RESEARCH
FOOD
ANIMALS HEV PCR
EPIDEMIOLOGY RESEARCH: GENOTYPING
SAME STRAIN
GENOTYPE 3
HEPATITIS E : FOOD-BORNE ZOONOSIS
• Main cause of acute viral hepatitis worldwide• Public Health problem in developing countries. • Emerging zoonotic disease in industrializated countries. • Subestimated (Not notifiable disease)• Unknown to many health professionals• Increase description of animal hosts• Increase transmission pathways
Balayan et al. 1983. Intervirology 20: 23-31
• RNA single-stranded (27-34 nm) • quasi-enveloped virus
Hepatitis E Virus
Family Hepeviridae
Genus Hepevirus
Stable in the environment for prolonged periods of time
§ Resists freezing
§ Inactivation: 56°C 1h, 71°C 20 min or 80°C 1 min.
Ø1 and 2: humansØ3 and 4: humans and animals (pigs, wild boars, deers, etc).Ø5 and 6 : wild boars (Asia)Ø7 and 8: camelids (Asia)
8 genotypes
Nimgaonkar et al., 2018
Chapuy-Regaud et al., 2017
Genotypes 1 and 2
Genotype 3
Ø Asymptomatic
ANIMALS
HUMANS
Ø Majority asymptomatic (>70%)
Ø Incubation period: 15-60 days
Ø Acute self-limited hepatitis (fatigue, fever, abdominal pain, hepatosplenomegaly, etc.)
Ø Chronic hepatitis in patients with previous liver disease (genotype 3)
Ø Extrahepatic symptoms: neurological disorders (Guillain-Barré), kidney dysfunction, pancreatitis, etc.
Ø High mortality rate (25%) in pregnant women (genotype 1)
§ No specific treatment
§ Ribavirin in chronic infections
§ Vaccine only available in China
Gráfica de PCR en tiempo real (VISAVET-UCM).Jothikumar et al., 2016
ELISA (VISAVET-UCM)
ELISA: IgM and IgG.
PCR: serum, faeces, liver, food, water, etc.GENOTYPING: Phylogenetic studies
SEROLOGICAL METHODS
MOLECULAR METHODS
ANIMAL MODELSCELL CULTURE LINES
VERY DIFFICULT EVALUATE INFECTIVITY, QUNATIFY VIRAL LOAD, EFFECTIVITY OF INACTIVATION TREATMENTS
Ø Every year: 20 million HEV infections worldwide, estimated 3.3 million symptomatic cases of hepatitis E (WHO)
Ø Mortality rate in pregnant woman 20-25%Ø Refugee camps (Niger, South Sudan, Kenya, etc.)
10 fold increase in the last ten years
First case of acute hepatitis in Escocia
2015: 5617 cases
>95% autochtonous cases
2005: 514 cases
Ø Main reservoir of the virusØ Seroprevalence HEV in Europe 30-98%.Ø Target organ: liverØ Also in the intestine, bile, lymph nodes, colon, muscle, blood, semen, etc.Ø Vertical and horizontal transmission
64,90%
46,10%
66,70%
83,50%
Huesca Zaragoza Teruel Toledo
PREVALENCIA HEV EN SUERO DE CERDO GRANJA
Farm Prevalence: 65,3% Slaughterhouse prevalence: 71,4%
Ø seroprevalence very variable (2-68%)Ø Genotypes 3, 4, 5 and 6Ø In all EuropeØ High zoonotic potential
© Wageningen University
Ø Very variable seroprevalence (1-13%)Ø Genotype 3 Ø In all Europe Ø Zoonotic potential
ØRabbitsØCamelidsØRodentsØAquatic mammalsØRuminantsØEquinesØetc.
Epidemiology HEV in France
• National seroprevalence: 22,4%
• 3 hiperendemic regions
• Estimations:ü 60,000 acute cases/yearü 500 hospitalizationsü 20 deaths
Mansuy et al, Hepatology 2016
Van Cauteren et al, 2018
Figatellu consumption
• Liver and derivates• meat
• Milk
• Moluscs
• Fruits and vegetables
- Mainly pigs and wild boars- Raw or poorly cooked
- Genotipes 1, 3, 4- Asia- cows, goats, sheep, camels, donkeys, humans
Water-borne contamination
- MANAGEMENT- BIOSECURITY
- CONTACT WITH WILDLIFE
-NEW RESERVOIRS
- WASTEWATER TREATMENT- MANURE
- BIOSECURITY
-COOKED (71ªC 20 MIN)
-CROSS CONTAMINATION
- HYGIENE MANIPULATORS and
UTENSILS
- HEALTHCARE PROFESSIONALS
- RISK PERSONNEL-CONSUMERS
-
- REAL PREVALENCE- TRANSMISSION ROUTES
- CELL CULTURES- ANIMAL MODELS
- PATHOGENY- INACTIVATION
METHODS- VACCINES-…
ANIMALS ENVIRONMENT FOOD INFORMATION RESEARCH
HEPATITIS E